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DoMESTiC VioLEnCE n 133

(Campbell, Rose, Kub, & nedd, 1998; irwin, risk of contracting a sexually transmitted dis-
Thorne, & Varcoe, 2002). nurse researchers ease (Alvarez et al., 2008; Silverman, Decker,
have identified a variety of strategies used Saggurti, Balaiah, & Raj, 2008) and cervical D
by abused women to resist abuse during the cancer (Coker, hopenhayn, DeSimone, Bush,
process of living in, and eventually leaving, & Clifford, 2009). Even after leaving the abu-
an abusive relationship (Ford-Gilboe, Wuest, sive relationship, women are still at risk
and Merritt-Gray, 2005; Wuest, Ford-Gilboe, for long-term health problems. For exam-
Merritt-Gray, & Berman, 2003) and how ple, Wuest et al. (2008) found that women
abused women strategize to protect their who have left an abusive relationship for
children’s safety and emotional well-being 20 months or longer continue to experience
(Ulrich et al., 2006). chronic pain.
Research indicates that women are most More recently, nurse researchers have
at risk for homicide from an intimate partner begun to explore the link between exposure
when they leave the battering relationship to domestic violence, chronic stress, and
(Wilson & Daly, 1993). nurse researchers poor overall health at the cellular level. in a
have made important contributions to this study involving formerly abused and nona-
body of knowledge. The Danger Assessment bused women, humphreys et al. (2011) find
was developed by Campbell (1986) to help that the length of telomeres (the protective
abused women realistically appraise their components that stabilize the ends of chro-
risk of homicide and enhance their self- mosomes and modulate cellular aging) is
care agency and has been tested in different significantly shorter among formerly abused
samples of abused women (Campbell, 1995; women. in addition, they find that the length
Campbell, Soeken, McFarlane, & Parker, of time in an abusive relationship is associ-
1998; McFarlane, Parker, & Soeken, 1995). ated with telomere length.
in a review of the research related to inti- Domestic violence also has economic
mate partner homicide, Campbell, Glass, consequences. health care costs are higher for
Sharps, Laughon, and Bloom (2007) iden- abused women compared with nonabused
tified prior domestic violence as the major women (Rivara et al., 2007; Snow-Jones et al.,
risk factor, with perpetrator gun ownership, 2006; Varcoe et al., 2009). Also, more severe
estrangement, stepchild in the home, forced abuse is associated with greater use of health
sex, threats to kill, and choking as the other care services (Ford-Gilboe, hammerton,
risk factors. Burnett, Wuest, & Varcoe, 2009).
There is overwhelming evidence that nurses can play a key role in effectively
women exposed to domestic violence expe- identifying domestic violence and providing
rience a wide range of long-term health follow-up referrals and supportive interven-
problems. Research has shown that domes- tions for women experiencing domestic vio-
tic violence is a significant risk factor for lence. Screening guidelines such as those
psychological and emotional health prob- developed by the Family Violence Prevention
lems, including depression (Dienemann Fund (2004) for health professionals and clin-
et al., 2000), substance abuse (Walton-Moss ical tools such as the Abuse Assessment
et al., 2003), and posttraumatic stress dis order Screen developed by the nursing Research
(Woods, hall, Campbell, & Angott, 2008). Consortium on Violence and Abuse (http://
Abused women have a 50% to 70% increase www.nnavwi.org) can help nurses to inte-
in gynecological, central nervous system, grate assessment of domestic violence in
and stress-related problems compared with their everyday practice. increasingly, nurses
nonabused women (Campbell et al., 2002). have developed interventions to ensure
Domestic violence also increases women’s abused women’s safety and to address their